Efficacy and tolerance of lactitol supplementation for adult constipation: a systematic review and meta-analysis

Abstract

BackgroundConstipation is a common complaint in adults. Lactitol is an osmotic disaccharide laxative that increases fecal volume and stimulates peristalsis. In this paper, we present the first meta-analysis on the efficacy and tolerance of lactitol for adult constipation.MethodsWe searched MEDLINE® and Embase, with no date or language restrictions, for studies of lactitol supplementation on adult constipation. A random-effects meta-analysis was performed on pre- to posttreatment changes in stool frequency and consistency with lactitol among all studies, as well as a comparison of efficacy and tolerance outcomes in randomized controlled trials (RCTs) of lactitol versus lactulose.ResultsA total of eleven studies representing 663 distinct patients were included in the final analysis, including five single-arm studies, four RCTs comparing lactitol with lactulose, one RCT comparing lactitol with placebo, and one nonrandomized controlled trial comparing lactitol with stimulant laxatives. Weekly stool frequency was significantly increased with lactitol compared with baseline (standardized mean difference [SMD]: 1.56, P<0.001). Stool consistency also improved over the supplementation period with lactitol (SMD: 1.04, P<0.001). Approximately one-third of patients experienced an adverse event; however, symptoms were generally mild and rarely (5%) resulted in study withdrawal. In RCTs of lactitol versus lactulose, lactitol was slightly more effective than lactulose in increasing weekly stool frequency (SMD: 0.19, P=0.06). No statistically significant differences between lactitol and lactulose were identified in any other efficacy or tolerance outcome. Lactitol demonstrated favorable efficacy and tolerance in individual studies when compared to stimulant laxatives and placebo.ConclusionLactitol supplementation is well tolerated and improves symptoms of adult constipation. The efficacy and tolerance of lactitol and lactulose are similar, with a trend for more frequent stools with lactitol. Limited evidence suggests lactitol is superior to stimulant laxatives and placebo for relieving constipation symptoms.

Chronic constipation in the elderly: a primer for the gastroenterologist

“…In a similar study comparing osmotic compounds sorbitol was as effective as lactulose on improving constipation, but was cheaper and better tolerated [ 65 ]. Lactitol efficacy has been extensively evaluated in the constipated adults, but the efficacy in the elderly is limited [ 66 ]. A recent meta-analysis concluded that the efficacy on improving symptoms of constipation of lactitol and lactulose are similar as well as tolerance to the drugs [ 66 ].…”

“…Lactitol efficacy has been extensively evaluated in the constipated adults, but the efficacy in the elderly is limited [ 66 ]. A recent meta-analysis concluded that the efficacy on improving symptoms of constipation of lactitol and lactulose are similar as well as tolerance to the drugs [ 66 ]. Finally, a double blind vs placebo study conducted by Ouwehand et al studied the effects of a symbiotic combination of Lactitol and Lactobacillus acidophilus NCFM on bowel function and immune parameters in a small group of healthy elderly [ 67 ].…”

Lactitol and the maintenance of normal defecation: evaluation of a health claim pursuant to Article 13(5) of Regulation (EC) No 1924/2006

“…In five out six studies in adults (Vanderdonct et al, 1990;Hammer and Ravelli, 1992;Goevaerts and Ravelli, 1993;Ravelli et al, 1995;Xu et al, 2012), stools were softer with supplementation than in the placebo or baseline groups, while in one study (Vanderdonckt and Ravelli, 1993) no significant change in stool consistency was found. A meta-analysis of these six studies (Miller et al, 2014) confirmed that stools were softer with lactitol consumption than in the baseline group. Owing to differences in reporting scales among studies, the standardised mean difference (SMD) was used to report this outcome, assuming that values of 0.2, 0.5, 0.8 and 1.0 represented small, medium, large and very large effect sizes, respectively.…”

“…In a meta-analysis (Miller et al, 2014), which included all of the nine studies conducted in adults mentioned above, lactitol ingestion (median daily intake of 20 g, median treatment period 28 days) increased weekly stool frequency compared with baseline, with a difference between the means of 3.8 stools per weeks (95 % confidence interval (CI) 3.2 to 4.3, p < 0.001).…”

Biological Activities of Lactose-Derived Prebiotics and Symbiotic with Probiotics on Gastrointestinal System

“…Different causes of constipation are: (a) consumption of food with lower fiber; (b) lower intake of water; (c) hormonal disorders (hypothyroidism, high levels of estrogen and progesterone); (d) stress; (e) not being active; and (f) intake of some medications, such as strong pain drugs such as narcotics, antidepressants and iron pills [ 200 , 201 ]. For a long time, lactose-derived prebiotics, mainly lactulose and lactitol have been popularly used for the treatment of constipation in people of different ages [ 202 , 203 ]. The mechanism is described in Figure 6 and the subsequent section.…”